Relationship of Factor VIII-like Antigen (VIII AGN) and Clot Promoting Activity (VIII AHF) as Measured by One-and Two-Stage Assays in Patients with Liver Disease

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Abstract
An increase in factor-VIII clot promoting activity as measured by a 1-stage assay (VIII AFH1) was observed in a hemophiliac with hepatitis. VIII AHF as measured by a 2-stage assay (VIII AHF2) was 0.013 .mu./ml at a time when VIII AHF1 measured 0.38 .mu./ml. Seven non-hemophiliacs with liver disease were studied and an attempt was made to correlate the levels of VIII AHF1 and VIII AHF2 with factor VIII-like antigen (VIII AGN) as measured by quantitative immunoelectrophoresis. In 4 of the 7 patients, disproportionate elevations of VIII AHF2 compared to VIII AHF1 were found. VIII AHF2 values correlated well with AGN values. No such discrepancy was apparent in 4 normal control subjects. The necessity for performing 2 stage assays in hemophiliacs as well as non-hemophiliacs with liver disease to assess factor-VIII levels is emphasized. Confirmation of the diagnosis of hemophilia may not be possible in the hemophiliac with hepatitis unless VII AHF2 determinations are performed. The reason for the disparity between VIII AHF1 and VIII AHF2 levels is not apparent. The correlation of VIII AGN and VIII AHF2 levels in the non-hemophiliacs with liver disease provides further support for the concept that VIII AGN and VIII AHF are closely related or identical molecular entities.